Relevance of ovarian preservation in young women with early-stage endometrial cancer after hormonal and surgical treatment: A comprehensive literature review
Keywords:
Ovarian preservation, endometrial cancer, recurrence-free survival, lymphadenectomy, premenopausal womenAbstract
Relevance: Ovarian preservation in young women with early-stage endometrial cancer after surgical treatment has been conventionally associated with complications. Nevertheless, recent randomized studies suggest a different perspective.
The study aimed to clarify the occurrence of complications, in particular relapses, associated with ovarian preservation in young women after hormonal and surgical treatment for early-stage endometrial cancer.
Methods: The analysis included articles published in full text over the past 10 years. We identified relevant observations from studies using a comprehensive search in the following databases: PubMed, Medline, Embase, and Cochrane Library. The search strategy included terms related to endometrial cancer: premenopausal, young woman, endometrial cancer, ovarian conservation. The study followed the PRISMA guidelines for systematic reviews.
Results: A total of 178 articles were studied, of which 111 articles (literature reviews and meta-analyses) (62%) described the cases of ovarian preservation. Of these, 84 were excluded for various reasons; 29 eligible articles were included in this analysis. Notably, factors such as younger age (P<0.0001), later year of diagnosis (p=0.03), residence in Central and Southern Europe and the United States (р=0.02), and lower-grade tumors in Asian countries (p<0.002) correlated with the desire of women to preserve their ovaries. The conducted literature review showed that ovarian preservation did not significantly affect cancer-specific survival (risk ratio (HR) =0.78, 95% CI 0.17-2.74) or overall survival (HR=0.78, 95% CI 0.24-1.75).
This study’s results remained practically unchanged even after excluding women after radiation and hormone therapy.
Conclusion: This literature review revealed no statistically significant difference in relapse-free survival between patients after ovarian preservation at stage IA and partially at stage II compared to those after bilateral salpingo-oophorectomy.
